Diseases of nasopharynx

1
Diseases of nasopharynx
2
DEFINITION of PHARYNX

• The pharynx is that part of the digestive tube
  which is placed behind the nasal cavities, mouth,
  and larynx. It is a wide musculomembranous tube,
  somewhat conical in form, with the base upward,
  and the apex downward, extending from the under
  surface of the skull to the level of the cricoid
  cartilage in front, and that of the sixth
  cervical vertebra behind .

3
(No Transcript)
4
NASOPHARYNX

• It lies behind the nose and above the level
  of the soft palate.
• It differs from the oral and laryngeal parts of
  the pharynx in that its cavity always remains
  patent.
• In front it communicates through the choanæ with
  the nasal cavities.
• On its lateral wall is the pharyngeal ostium of
  the auditory tube, somewhat triangular in shape,
  and bounded behind by a firm prominence, the
  torus or cushion,.Behind the ostium of the
  auditory tube is a deep recess, the pharyngeal
  recess (fossa of Rosenmüller).
• On the posterior wall is a prominence, best
  marked in childhood, produced by a mass of
  lymphoid tissue, the adenoids.

5
(No Transcript)
6
The adenoids

• are a clump of lymphoid tissue similar to that of
  tonsils, but located higher up in the throat,
  behind the nose. Adenoids help the body fight
  infections by trapping and fighting micro
  organisms as they pass through the breathing
  passage.

7
Indications for adenoidectomy

• Adenoidectomy is indicated if there is a chronic
  effusion in the middle ear in an adult,
  especially on one side only, which does not
  resolve relatively rapidly (3-6 weeks) with
  proper medical treatment. 
• Obstruction behind the nose causing snoring,
  airway obstruction, or poor sleep

8
Adenoidectomy Indicated when

• Enlarged adenoids are blocking the airway, which
  may be suspected if the child
• snores excessively
• has trouble breathing through the nose
• has episodes of not breathing during sleep
  
• The child has chronic ear infections that
• interfere with child's education
• persist despite antibiotic treatment
• recur 5 or more times in a year
• recur 3 or more times a year during a
  2-year period

9
Adenoidectomy

• The adenoids normally shrink as the child reaches
  adolescence and adenoidectomy is rarely needed
  after reaching the teenage years. Adenoidectomy
  can done as an outpatient procedure in good set
  ups.. Complete recovery takes 1 to 2 weeks. While
  healing, the child may have a stuffy nose, nasal
  drainage, and a sore throat. Soft, cool foods and
  drinks may help relieve throat discomfort.

10
ADENOID CURETTES
11
Laser adenoidectomy
12
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA


13
definition
angiofibromas are highly vascular,
non-encapsulated tumours affecting predominantly
young males. These lesions are benign
histologically but they may become
life-threatening with excessive bleeding or
intracranial extension.
14
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

• STUDY PERIOD 1984 TO 2004
• 60 CASES

ALL CASES EVALUATED ACCORDING TO A QUESTIONNAIRE
FOLLOWUP 18 MONTHS TO 4 YEARS PRE-OP
TRACHEOSTOMY IN ALL PATIENTS
15
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

• 60 CASES

ALL MALES AVERAGE AGE 17 YEARS
(RANGE 12-22 YRS)
16
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

• COMMON PRESENTATION
• N 60

EPISTAXIS NASAL BLOCKAGE EAR COMPLAINTS FACIAL
SWELLING
17
C T SCAN
18
ANGIOGRAPHY
19
TUMOUR BLUSH
20
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

• COMPLICATIONS

PRIMARY HAEMORRHAGE 1 L (Ave) SECONDARY
HAEMORRHAGE 3 PATIENTS WOUND INFECTION 3
PATIENTS CONDUCTIVE HEARING LOSS 1
PATIENT HYPERTROPHIED SCAR 3 PATIENT
21
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

• FOLLOWUP
• 18 MONTHS TO 4 YEARS

RECURRENCE 11 PATIENTS (18.3 )
22
JUVENILE NASOPHARYNGEAL ANGIOFIBROMACONCLUSIONS

• SURGERY IS THE TREATMENT OF CHOICE
• MOST COMMON PRESENTATION IS EPISTAXIS
• BEST APPROACH IS TRANSPALATAL WITH LAT. RHINOTOMY
• FOLLOW UP CT SCAN AFTER 6 MONTHS